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[中风治疗中的艰难决策]

[Difficult decisions in stroke therapy].

作者信息

Endres M, Grond M, Hacke W, Ebinger M, Schellinger P D, Dichgans M

机构信息

Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Deutschland.

出版信息

Nervenarzt. 2011 Aug;82(8):957-72. doi: 10.1007/s00115-011-3259-x.

DOI:10.1007/s00115-011-3259-x
PMID:21789692
Abstract

In numerous situations stroke physicians face a lack of evidence during their daily practice. In this report the authors address some of the difficult treatment decisions encountered in acute therapy and secondary prevention. Examples include off-label thrombolysis and prevention in high-risk situations. The available data from trials and registries are discussed, and personal views and recommendations are expressed.

摘要

在众多情况下,中风科医生在日常临床实践中会面临证据不足的问题。在本报告中,作者探讨了急性治疗和二级预防中遇到的一些艰难治疗决策。示例包括超说明书溶栓治疗和高风险情况下的预防措施。文中讨论了来自试验和登记处的现有数据,并表达了个人观点和建议。

相似文献

1
[Difficult decisions in stroke therapy].[中风治疗中的艰难决策]
Nervenarzt. 2011 Aug;82(8):957-72. doi: 10.1007/s00115-011-3259-x.
2
How good is the management of vascular risk after stroke, transient ischaemic attack or carotid endarterectomy?中风、短暂性脑缺血发作或颈动脉内膜切除术后的血管风险管理效果如何?
Cerebrovasc Dis. 2007;23(2-3):156-61. doi: 10.1159/000097053. Epub 2006 Nov 16.
3
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Cerebrovasc Dis. 2008;25(3):254-60. doi: 10.1159/000113864. Epub 2008 Jan 24.
4
Clinical practice. Secondary prevention after ischemic stroke or transient ischemic attack.临床实践。缺血性中风或短暂性脑缺血发作后的二级预防。
N Engl J Med. 2012 May 17;366(20):1914-22. doi: 10.1056/NEJMcp1107281.
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Compr Ther. 2005 Summer;31(2):113-8. doi: 10.1007/s12019-005-0006-x.
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The management of stroke patients by neurologists: common questions and new observations.神经科医生对中风患者的管理:常见问题与新观察
Semin Neurol. 2002 Mar;22(1):53-61. doi: 10.1055/s-2002-33048.
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Stroke prevention.中风预防。
Clin Evid. 2002 Jun(7):175-98.
8
Atrial fibrillation, is warfarin the only option for stroke prevention?心房颤动,华法林是预防中风的唯一选择吗?
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[Secondary prevention after stroke: healthy life style, oral anticoagulation].[中风后的二级预防:健康生活方式、口服抗凝治疗]
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Relation of effective anticoagulation in patients with atrial fibrillation to stroke severity and survival (from the National Acute Stroke Israeli Survey [NASIS]).心房颤动患者有效抗凝与卒中严重程度和生存的关系(来自以色列国家急性卒中调查 [NASIS])。
Am J Cardiol. 2010 Feb 1;105(3):411-6. doi: 10.1016/j.amjcard.2009.09.050. Epub 2009 Dec 22.

本文引用的文献

1
Validity of HAT score for predicting symptomatic intracranial hemorrhage in acute stroke patients with proximal occlusions: data from randomized trials of sonothrombolysis.HAT 评分预测近端闭塞急性卒中患者症状性颅内出血的有效性:来自 sonothrombolysis 随机试验的数据。
Cerebrovasc Dis. 2011;31(5):471-6. doi: 10.1159/000324387. Epub 2011 Mar 3.
2
Intravenous thrombolysis based on diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch in acute stroke patients with unknown onset time.基于弥散加权成像和液体衰减反转恢复不匹配的急性脑卒中患者静脉溶栓治疗:起病时间不明患者的研究。
Cerebrovasc Dis. 2011;31(5):435-41. doi: 10.1159/000323850. Epub 2011 Feb 23.
3
Age-dependent gender differences in hypertension management.
高血压管理中的年龄相关性别差异。
J Hypertens. 2011 May;29(5):1005-11. doi: 10.1097/HJH.0b013e3283449512.
4
The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial.血管紧张素受体阻滞剂坎地沙坦治疗急性脑卒中(SCAST):一项随机、安慰剂对照、双盲试验。
Lancet. 2011 Feb 26;377(9767):741-50. doi: 10.1016/S0140-6736(11)60104-9.
5
Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).颈动脉血运重建内膜切除术与支架置入术试验(CREST)中症状状态对支架置入和内膜切除术安全性的影响。
Stroke. 2011 Mar;42(3):675-80. doi: 10.1161/STROKEAHA.110.610212. Epub 2011 Feb 9.
6
"Triple therapy" rather than "triple threat": a meta-analysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment.三联抗栓治疗而非三联威胁:长期口服抗凝治疗患者支架植入术后两种抗栓方案的荟萃分析。
Chest. 2011 Feb;139(2):260-270. doi: 10.1378/chest.09-3083.
7
Age modifies the relative risk of stenting versus endarterectomy for symptomatic carotid stenosis--a pooled analysis of EVA-3S, SPACE and ICSS.年龄改变了症状性颈动脉狭窄支架置入术与颈动脉内膜切除术的相对风险——EVA-3S、SPACE 和 ICSS 的汇总分析。
Eur J Vasc Endovasc Surg. 2011 Feb;41(2):153-8. doi: 10.1016/j.ejvs.2011.01.001. Epub 2011 Jan 26.
8
Thrombolysis in very old people with stroke: stroke subtypes, patterns, complications, and clinical outcome.高龄卒中患者的溶栓治疗:卒中亚型、模式、并发症及临床结局
J Am Geriatr Soc. 2011 Jan;59(1):178-80. doi: 10.1111/j.1532-5415.2010.03226.x.
9
Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score.新型房颤抗凝出血风险评分对预测抗凝出血风险的比较验证:HAS-BLED(高血压、肾功能/肝功能异常、卒中、出血史或倾向、INR 易变、高龄、同时使用药物/酒精)评分。
J Am Coll Cardiol. 2011 Jan 11;57(2):173-80. doi: 10.1016/j.jacc.2010.09.024. Epub 2010 Nov 24.
10
Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive.非常老年人的溶栓治疗: SITS 国际卒中溶栓注册研究和虚拟国际卒中试验档案的对照比较。
BMJ. 2010 Nov 23;341:c6046. doi: 10.1136/bmj.c6046.